State Medicaid officials have refused to pay for a liver transplant for an Altoona man because he is infected with HIV, a position the man's attorneys argue is discriminatory and not based on current medical knowledge and practice.

William Jean Gough, 46, meets the medical criteria for the procedure and his survival chances are as good as someone who isn't infected with the AIDS virus, said Hayley Gorenberg, AIDS project director at Lambda Legal in New York, which, along with the AIDS Project of Pennsylvania, is representing Gough in his appeal of the decision.

Live transplant is an incredibly difficult and bloody procedure. They can bleed more than anyother surgery, and the lines necessary to safely do this proceudre as multiple and complex. This is horrendously risky for both the surgeon and the anesthesiologist.

You're right we are all dying, but we all haven't fast tracked ourselves in that process by engaging in risky behaviors.

He either caught AIDS and Hep C by sharing needles or through his sexual practices. Had he caught it through a blood transfusion you can bet they'd have mentioned it. Either way neither of those diseases is curable and both are ultimately fatal.

There's an organ shortage as it is in this country, there's no point in putting the few that are available into people with terminable diseases that replacing an organ won't fix.

Cancer is cancer, they could have done the same thing the aids activists did and called what happens to the body as a result "cancer related illnesses" but it still wouldn't change the fact that the cancer killed you. You get HIV and the results of the HIV is the destruction of the immune system and a subsequent breakdown. Calling the process by which the HIV virus kills the body by another name doesn't change the fact that contracting the HIV virus caused the breakdown.

Big drinkers ruin their livers - they are fasttracked to death because of their behavior. Yet, they get organs just like anyone else would/

It's case by case. I'm with you though - the whole organ industry royally sucks, but what can we do? Until we can develop machines that can be used for organs, or be able to clone organ parts, it's a sucky system out there.

14
posted on 11/21/2003 1:08:01 PM PST
by HitmanLV
(I will not be pushed, filed, stamped, indexed, briefed, debriefed or numbered. My life is my own.)

I just shudder to think of this guy getting a liver that could have gone into some kid instead and the kid dying waiting for another one while the diseases that this guy has contracted continue to ravage his body and the new organ.

In a case like this that guy should be last on the list, if everyone else that could be offered the organ refuses it then he gets his shot.

Important points: 1. Is Hepatitis C eradicated from the body after a liver transplantation? If not, what are the chances of the transplanted liver being ruined by the Hepatitis? 2. HIV patients are usually on multi-drug "cocktails"; are these meds toxic to the liver? If so, then that would shorten the survival of the transplanted liver 3. What stage of HIV is he in; if he is in the later stages, then a "triage" decision must be made to defer the organ to someone who does not have a disease that would shorten that recipient's lifespan (in my humble opinion). 4.; There is a shortage of donor organs, thus a moral decision will probably enter into the equation (giving the organ to a person who has a liver condition that is genetic or congenital as opposed to someone who has liver disease as a result of behavioral choices.

My guess would be that he received the diseases via either a blood transfusion, or through drug abuse. Hep C is not commonly transmitted sexually.

22
posted on 11/21/2003 1:17:39 PM PST
by Born Conservative
("Forgive your enemies, but never forget their names" - John F. Kennedy)

My brother - an interventional radiologist, the medical specialty that performs surgical procedures via catheters and other special tools introduced into the body via the circulatory system - was infected with hepatitis C from one of his patients at the teaching hospital where he used to work. It probably happened as a result of a glove failure, but that was never established. He could still have taught, if interferon treatment had succeeded, but instead it caused clotting problems that eventually cost him use of one arm, on top of the infection that will destroy his liver in the next few years. He has also lost a kidney, and needs colon surgery but has not decided that it is worth the ordeal.

Every time I talk to him the subject of whether his life is worth living seems to arise. He used to be physically active, but any exertion now leaves him weak and confused due to associated problems with circulation to his brain. A transplant would not change that, or restore use of his arm.

Dangerous for the surgeon? Yes, I think so. I know so. And my brother is worth more than every one of these low-lifes that ever existed.

1. hepC is NOT eradicated by a transplant, and eventually the transplant probably will be damaged or destroyed by it. That said, understand that hepC is the MOST FREQUENT REASON for a liver transplant.

2. and 3. I have no answer.

We clearly need to define new priorities for organ access. While no usable organs should go to waste, prisoners and illegal aliens shold be moved way down the list, subject to the specific wishes of the donor or donor family. Tissue match, health, and physical condition are primary, of course. But long term survival is a reasonable issue, and HIV has to be part of that.

The recent case of a death row prisoner receiving a heart is a travesty. Some real, honest, lawful citizen died for that.

I was referring to his remark about organ transplant system.But my liver keeps taking the hits from the transplant meds. Heart is doing great thank you.I had liver biopsy two months ago every fine so far.

Actually, he has told me that in his condition, the trauma of a transplant that would still leave him crippled is not worth it. He would not allow me to be tested for a lobe transplant a couple of years ago, and now I am over the age limit.

The doctors and nurses are not at risk from catching cirrhosis though. Just as in life, many HIV and AIDS carriers don't care about how many they infect. They don't care while they are dying either. And of course, the nurses can't opt out. It's not a matter of saving a life anymore but a matter of dying because of others lifestyles and their "rights" to do whatever feels good.

I like the idea of "you have to be willing to give in order to receive". Makes sense to me! That would encourage more people to register as organ donors and make more organs available to everyone. New Light (I like new ideas.)

Absolutely. It's something that should, and is, taken into account when they are being screened.

For instance if a smoker is in need of a lung transplant but refuses to quit smoking that person would be turned down.

If someone engages in risky behavior, needle sharing etc. and as a result they contract Hep C then the fact is that even if they get an organ they may go right back to participating in the same behavior rendering the donated organ ultimately useless.

Meanwhile someone who had a congenital defect or caught Hep C through no fault of their own may have to continue to wait.

Just curious -- how risky is it for the surgeons? They are dealing with infected blood.

Just life or death for the surgeons. One nick with a scalpel or if they stick themselves with a suture needle it could be a death sentence. Something all of us in medicine deal with on a daily basis. At least in this case they KNOW. Most of the time we DON'T.

45
posted on 11/24/2003 6:36:31 AM PST
by Kozak
(Anti Shahada: " There is no God named Allah, and Muhammed is his False Prophet")

A distinction without a difference. The only time I am aware of that having the infectious organism isn't considered a disease. If you are infected with Hepatitis B virus, you have Hepatitis B even if assymptomatic. If you have Plasmodium Falciparum in your RBC's or liver you have Malaria, even if you have no crisis. This HIV AIDS distinction is a political legacy of the early days when we did not have an organism and diagnosis was based of clinical findings. It's medically meaningless now.

46
posted on 11/24/2003 6:41:47 AM PST
by Kozak
(Anti Shahada: " There is no God named Allah, and Muhammed is his False Prophet")

And the definition of AIDS is? Here's a description of the disease process ( and it is a disease look up the definition of "disease"). From the CDC Web site.

SYMPTOMS OF HIV INFECTION Many people do not have any symptoms when they first become infected with HIV. Some people, however, have a flu-like illness within a month or two after exposure to the virus. This illness may include Fever Headache Tiredness Enlarged lymph nodes (glands of the immune system easily felt in the neck and groin These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, people are very infectious, and HIV is present in large quantities in genital fluids.

More persistent or severe symptoms may not appear for 10 years or more after HIV first enters the body in adults, or within two years in children born with HIV infection. This period of "asymptomatic" infection is highly individual. Some people may begin to have symptoms within a few months, while others may be symptom-free for more than 10 years.

Even during the asymptomatic period, the virus is actively multiplying, infecting, and killing cells of the immune system. The most obvious effect of HIV infection is a decline in the number of CD4 positive T cells (also called T4 cells) found in the blood -- the immune system's key infection fighters. At the beginning of its life in the human body, the virus disables or destroys these cells without causing symptoms.

As the immune system worsens, a variety of complications start to take over. For many people, the first signs of infection are large lymph nodes or "swollen glands" that may be enlarged for more than three months. Other symptoms often experienced months to years before the onset of AIDS include

So you see, it's a difference without a distinction. They may not become symptomatic for years or decades, but the virus is in there, slowly killing their immune system. Some people seem to have a genetic predisposition to slower progression, ala Magic Johnson, don't bet on his being alive in 20 years.

50
posted on 11/24/2003 7:05:02 PM PST
by Kozak
(Anti Shahada: " There is no God named Allah, and Muhammed is his False Prophet")

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